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I have been appealing my insurance company's denial of therapy benefits. My contract says that I'm entitled to 30 visits a year and unlimited visits if I have a biologically based disorder. I'm out of my 30 visits. So, T changed my diagnosis to anxiety and we asked for unlimited visits and they were denied. I appealed to the NYS insurance department who supposedly had an independent psychologist review my case and his decision was horrible. I feel so violated and disgusting.

He said that I have been in therapy for 4 years (most of it every other week) and that I should have been able to reap all the benefits that psychotherapy has to offer. He also said that his recommendation is that I be terminated but given 6 termination sessions and that I should be referred to outside agencies, support groups, etc.

He signed an affidavit saying that he was a neuropsychologist who has been in practice for 25 years and he's been published in so many journals, etc. etc. I mean, sometimes I wonder why my T doesn't give up on me because I don't think I make much progress. But I don't really want to go there in my head. It's not a nice place. As long as he doesn't give up on me, I'll keep trying to keep my head afloat.

I can't understand why he would recommend termination? Why does he care how long I go to therapy for? It made me feel like my relationship with my T is sick and pathological. I got the letter yesterday an hour before my appointment and nearly lost it. T doesn't agree with the recommendation at all (hey I'm finally starting to trust him after all this time) but he hadn't gotten the letter when I saw him yesterday.

T basically told me that these psychologists are given bonuses to deny people benefits. But what's bothering me today is how he could make such a drastic recommendation with so few facts? The only thing I could think of is that he was covering the insurance company's butt if I decided to sue.

I want Yaku's insurance company.
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Oh, Liese! I'm so sorry. They tried to deny me at first too, saying I could just go to some other person. T had to (nicely) fight for why I should stay with him. He didn't tell me what his argument was, but I'm thinking it either has to do with attachment issues or sensitive issues type reasons...or both. Can you keep appealing? I don't know what the insurance situation is, but if it's through a workplace, open enrollment should roll around in a few months and maybe you could switch? Frowner I'm so angry at these people. There is nothing sick about your relationship with your T and I hate that some stranger's long distance analysis is causing you to question that. I have friends who were in therapy over half their lifetime with the same therapist and found healing that way. For what it's worth, in the short time that I've been here, I think I've seen you make TONS of progress in learning to trust your T, risk being truly open with him, etc.

My approval runs through January and I'm really scared...what if they don't renew it after that? What if they decide, "Oh, she's stable enough," and demand I go see the dissociative disorder specialist who sent me the demon stuff? My T says these peoples' jobs are to give as little service as possible to maximize the company's profits. When I told the pdoc about it, she said she often has to make a very clear point about the patient's stability in order to get them to budge at all.

(((((((hugs)))))))) I wish I could fix it for you somehow. Does your T say whether there is any next step?
(((YAKU)))

I don't know if there is another appeal but I feel so exposed and vulnerable that I couldn't even go through it. I just can't have my mental health and my feelings exposed like that. I'd much rather pay for therapy myself. It feels like someone just tore me a new you know what and once again told me my reality isn't real. I know for a fact that if it wasn't for my T this past year, I would have wound up in the hospital.

My choices now are to pay out of pocket or switch insurance companies. Well, I have been paying out of pocket since my 30 visits ran out anyway.

I'm sorry you are so scared they might terminate your benefits next year. Why isn't recovering from a lifetime of trauma a good enough reason to qualify for therapy? I wonder when they will realize that when our mental health is good, we're more productive, get sick less, etc. It's really the first thing they should cover.
I've just decided that I'm going to look at this as a positive instead of that I've been crapped on again. In the trauma literature it says that the people who can find meaning in their lives and from their issues do better than the ones who don't. I've been looking and looking for meaning but haven't been able to find any.

This wasn't personal. This wasn't about me. There are larger forces at work here. And, maybe the meaning I can find in my life is after I recover, I will help people fight for mental health benefits and fight to change the mental health insurance laws.

Suddenly the world seems a little better.
Liese that is a great attitude to have. We need people to fight for mental health benefits for those who need it. I'm sorry you had to hear this news but I can understand why you felt that way. Very exposed. I would have been both furious and devastated. I wrote more about my own situation with insurance on Yaku's thread on insurance.

My T says that insurance companies are stupid because by allowing therapy they are saving a LOT of money that would otherwise be spent on hospitalization/inpatient services for those who can be helped via outpatient therapy on a weekly basis. He says it's all a big game and they do not care about the people, just the profits. My T does NOT like insurance companies... which makes me love him even more LOL.

As for me... I'm hoping that in October I hear that my dh's company is not switching plans or I may be in an insurance mess myself. Like we don't already have enough on our plates to deal with.

Hang in there Liese.
Hugs
TN
((((STRM))))(((((TN)))))(((((MONTE)))))(((((DF))))

Thank you all for you support. When I got the letter on Monday, my head was spinning with all kinds of crazy thoughts. I couldn't separate out that this guy actually has no control over my therapy - except to say who might kick in for the payments. It was lucky I had an appointment with T an hour later. But then yesterday, I started to imagine T getting his letter - because he didn't get it on Monday - and reading what this jerk of a psychologist wrote. And my mind went to dark places imagining his reaction and I got triggered all over again. All the hard work in terms of trusting T went momentarily out the window. But I know our relationship is solid and my therapy is solid and I'm not going to worry about the payments for now. My H is supportive of me going. He told me last night the children need their mother to be mentally healthy. And T is supportive and even told me that if money becomes an issue, not to worry that we'll sort it all out later. So, I don't have any immediate worries. I just have to remember that.

I'm slightly dreading my appointment tomorrow since I've managed to calm myself down about it all but I'm sure T will have gotten his letter by tomorrow. I know he's going to have a very negative reaction after he reads what this guy wrote. (He doesn't like the insurance companies either TN) And, I'm sure he will bring it up again. I just want to push it out of my mind and move forward. I threw my letter out and never want to think about it again. I guess I'll just have to be assertive with T and tell him I don't want to talk about it. Frowner How naive of me to think I could take on the insurance companies. Wink Erin Brockovich watch out!!! Here I come!! LOL!!!
Shit a brick Liese. This is horrible.

I am sorry but reading your post triggered all my feelings from the past 6 days and has upset me. As soon as I read termination and 6 sessions - I dissociated and could'nt read. I can't offer you any advice right now. I just don't understand the insurance system you guys have over there. It sounds crazy to me.

Please take things slowly Liese and use your T's help.
I am so sorry to read what you are going through, Liese. Frowner What an awful, arrogant thing to be told, that you should be all better by now. How the hell would HE know? Mad I really admire that attitude that you're taking with it, though...you are right, there are larger forces at work here, and it's nothing personal, just the mighty dollar making itself heard...but it still hurts, and is very frustrating. I'm really glad to see you talking about it here...and I hope you're able to find a way to still have therapy, one way or the other. Good luck to you Smiler

Hugs,
SG
((((SG))))

Thanks for the hugs and the sympathy. I WAS doing okay with it all but then got my $50.00 check back in the mail today. I had to pay $50.00 for the appeal. And so I called the woman who sent the check back and asked her why she went the check back. She told me it was because the original decision was modified from 2 visits to 6 visits and so I guess that means I don't have to pay for my appeal.

It all got me hot and bothered again because I realized from a legal perspective, if a lawyer gave that kind of an opinion with so few facts that would be reckless at one extreme and/or legal malpractice at the other. He didn't have much information in front of him and so for him to come to the conclusion that I should terminate therapy because it appeared I was "in maintenance" was really quite astounding at the very least. I was toying with reporting him to the state board that holds his license but I am not sure if I should, if it would be vindictive. And of course, I wouldn't want to open myself up to having to give more information about myself.

Anyway, I think I will let it go for now ...

xoxo

Liese
Hey, Liese- I'm so sorry that you are being treated so unfairly by the insurance company. I'm just appalled that a T who never even met you, and knows nothing of your story would make such a rash judgement based on money- grrrr. Insurance companies are the devil, they treat people like commodities to be consumed...by them. I really feel for you. ((((((Liese)))))))

I hope it will all get sorted out soon, and you will feel better.

hugs,

BB
Thanks BB. We're actually just going to switch insurance companies and so at least I'll get my 30 visits again now and at the beginning of the year again so it shouldn't be an issue for at least 8 months ... and maybe by then I'll have a job and be able to pay for therapy!!!! My H deals with a lot of insurance companies and these "independent" consultants. He said they are always looking to terminate benefits and it's very maddening for him because a lot of his clients can't get the treatment they need. But my H supports me going to therapy and so at least I don't have a battle at home about that!!! Getting over my anger at that stupid idiotic psychologist. Well, maybe not just yet. But I'm working on letting it go and enjoying the wonderful things in life.

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